@mandeep_mayo I see a proximal filling defect after the Ostial stenosis. Could be a small valve or plaque rupture, distally calcified stenosis but I don’t see the anastomosis clearly from this view
@mwaqaschoudhry@Ayman_Elbadawi_@djc795@DrMauricioCohen@SVRaoMD@TrOpLeAk85 Tough decision, young pt, diabetic, diffuse long lesion but not super low FFR. I would try medical mgt first, optimize risk factors, and have a team discussion. If the pt elects to go with pci, I would go provisional ivus guided long pci of lad, wire diagonal and ptca if needed
@OKhaliqueMD We should respect each other regardless of what role we do, everyone is participating to pt care in a way they love to practice. Identifying endocarditis is as important as replacing a valve. Bringing EF back to normal takes more effort and passion than deploying a stent.
@mandeep_mayo Had a similar case, after several attempts lost the lcx from wiring, eventually pilot with cto 1mm curve was able to cross and re-established flow. The next challenge will be to advance any device there.